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. 2019 Mar;17(2):100-107.
doi: 10.1370/afm.2367.

Systolic Blood Pressure and Cognitive Decline in Older Adults With Hypertension

Sven Streit  1 , Rosalinde K E Poortvliet  2 , Wendy P J den Elzen  3 , Jeanet W Blom  2 , Jacobijn Gussekloo  4   5
Affiliations

Systolic Blood Pressure and Cognitive Decline in Older Adults With Hypertension

Sven Streit et al. Ann Fam Med. 2019 Mar.

Abstract

Purpose: Hypertension trials often exclude patients with complex health problems and lack generalizability. We aimed to determine if systolic blood pressure (SBP) in patients undergoing antihypertensive treatment is associated with 1-year changes in cognitive/daily functioning or quality of life (QoL) in persons aged ≥75 years with or without complex health problems.

Methods: We analyzed data from a population-based prospective cohort study (Integrated Systematic Care for Older Persons [ISCOPE]) with a 1-year follow-up. Stratified by SBP level in the year before baseline, we used mixed-effects linear regression models to evaluate the change from baseline to 1-year follow-up in outcome measures (Mini-Mental State Examination [MMSE], Groningen Activity Restriction Scale [GARS], and EQ-5D-3L). We adjusted for age, sex, and baseline MMSE/GARS/EQ-5D-3L scores and stratified for complex health problems as a proxy for frailty.

Results: Participant (n = 1,266) age averaged 82.4 (SD 5) years, and 874 (69%) were women. For participants undergoing antihypertensive therapy (1,057; 83.5%) and with SBP <130 mm Hg, crude cognitive decline was 0.90 points MMSE, whereas in those with SBP >150 mm Hg, it was 0.14 points MMSE (ie, 0.76-point less decline; P for trend = .013). Complex health problems modified the association of SBP with cognition; the association was seen in those with antihypertensive treatment (P for trend <.001), not in those without (P for trend = .13). Daily functioning/QoL did not differ across the strata of SBP or antihypertensive treatment.

Conclusions: Participants aged ≥75 years undergoing antihypertensive treatment, with SBP ≥130 mm Hg compared to <130 mm Hg, showed less cognitive decline after 1 year, without loss of daily functioning or QoL. This effect was strongest in participants with complex health problems. More studies should be conducted to determine if there is a causal relation and to understand the mechanism of the association observed.

Keywords: cognitive function; daily functioning; hypertension; old age; quality of life.

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Figures

Figure 1
Figure 1
Study flowchart BP = blood pressure; EMR = electronic medical record; ISCOPE = Integrated Systematic Care for Older Persons study.
Figure 2
Figure 2
Associations between systolic blood pressure, antihypertensive treatment, and change in function after a 1-year follow-up. GARS = Groningen Activity Restriction Scale; MMSE = Mini-Mental State Examination. Note: Numbers in or above bars equal number of participants. Estimates, 95% CI, and P for trend from crude mixed-effects linear regression accounting for clustering within family physicians. A. Cognitive function measured by MMSE (fewer points = cognitive decline). B. Daily functioning measured by GARS (more points = more disability). C. Quality of life measured by EQ-5D-3L (fewer points = lower quality of life).
Figure 2
Figure 2
Associations between systolic blood pressure, antihypertensive treatment, and change in function after a 1-year follow-up. GARS = Groningen Activity Restriction Scale; MMSE = Mini-Mental State Examination. Note: Numbers in or above bars equal number of participants. Estimates, 95% CI, and P for trend from crude mixed-effects linear regression accounting for clustering within family physicians. A. Cognitive function measured by MMSE (fewer points = cognitive decline). B. Daily functioning measured by GARS (more points = more disability). C. Quality of life measured by EQ-5D-3L (fewer points = lower quality of life).
Figure 2
Figure 2
Associations between systolic blood pressure, antihypertensive treatment, and change in function after a 1-year follow-up. GARS = Groningen Activity Restriction Scale; MMSE = Mini-Mental State Examination. Note: Numbers in or above bars equal number of participants. Estimates, 95% CI, and P for trend from crude mixed-effects linear regression accounting for clustering within family physicians. A. Cognitive function measured by MMSE (fewer points = cognitive decline). B. Daily functioning measured by GARS (more points = more disability). C. Quality of life measured by EQ-5D-3L (fewer points = lower quality of life).
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